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BUILDING- INSPECTOR RECORDafl coMMENrsSITE.WORK rolstA-/ Set Backs II .}' Erection Pads UFER Ground SLAB Floor Subf loor/VenUl nsulation Roof Sheathing tr/&1,'1 H.J?L ta1 Shear Wall Framing ln s u lation/Energy Drywall Ext./lnt. Lath Brown Coat Ivlasonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif. F|NAL 1//6//q //,r/z- tocl Certificate of Occupancy t Notes, Remarks, Etc OWNIiR Bt]II-DT]R DDI,CARATION I hocty amm undd p.nalry.l rErjury lhar I m .\.nrFt ftorr thc Conlrt.lo6 Licnsc liLv lu lhc aollo\in3 r.Nrn (sâ‚¬ 70.115 uusinss atrd flof6sion CG.jc), Any ( iry or aounrv \ehich r.qui'6 a Pdmit lo consrrud ah6. imPror.. d.nolih or r.!6n v nfldurâ‚¬. priorro irs i$uan... sle râ‚¬qun6lhc alplicanl a.' su.h p.mil tu filc ! si!..d sraran.trt lhal hc or $c b lic6.d puFuad ro rhc Fovisions ol ihâ‚¬ Conlrackri l-i..trs.d b$ (Chapr6 q. Conrnd.in! trnh S(lion 7Om of Division 1 ol rh. Busin6s and I'roLsionsCodc)o!rharhc.rsh.is.rcnlprlhqeftom d lh. ttssis n! rh. allcrert crdflnJ. An' violalion o I sdion 70115bv.nv .ppli.aori.rapmlrsobi(lslhcapplicaflroacivilp.n.lryofnolmor.thdir.hu.dr.ddollars($500) l. s o\ nd oflhc pmpeny. .r my .mplo) 6 $ilh t ar6 as lh.n sn. c.nrmsalion. \ ill do lhe \rod md lhc nn(lu. ir n'r inrdded or olt6.d lir el. (S( 70,11.l'lusinss and Ptuf*ioB c.d.: lhcConhaclois l-icdsc I-a\ do6 nol atplv t. 0. o$n-ol rh. fi.rdy uho ttuilds or nnFo\ 6 rh6on. dd $ho do6 such \!rl hinscllor hmclfor thmuah hn or hd o*r mplo)c6 !l ov id.d rhar such ,nprolodts e nol inrFddl d .frod for sl. I I io\.\ r. rh. t[ildin3 or impnr 4rol t end $ihin onc tw olcomplclion. lhâ‚¬ (}116 Buildr {ill h.!. lh. htrtlo ot tro\ins lhd h. or she dil mt blild or iqnov. fi. Impqlv for rh. lurlFsc of l. s offir oflhc FoIHr, m .rclusivcly contr&r i.g tr nh li.ft.d conlllcloE k' .lnnrud rh. proj.d (S< ?o44, Bchs and Bba6ixCod.r'l hâ‚¬ Conrtdoa3 Li.ms. Los do6 nol orDly to do$nd oaprcp.nyrvho b!il& or imprord rhden. and *ho co'nEcrs for such Eoj.rls wilh 6 Conrdclo(s) licds.n Puuur ro lh. c.ntradois LicoF t,w} I m.r.nF udd S.dion- ,B &PC lor this rca$n Irrr.' Orn..' wonxf,R's'co[rPE sarloN DECIAEAIIQ! I h(cby amm und6 p6Ehy ol pdjury on ofrh. lollosins d..lmrioN lh6vca{l*ill daintain r C.n iaEslc otconsol lo Scl ftu.. aor \ort6 comFtua'io.. s p.ovidâ‚¬d for bvSdion1700orlhc L{bo. Codc. for lh. paforruc. of lfiâ‚¬ wort aor Ntich rh. Fnn ie isuqj. I h.!. and will mninllin rvork6- conp.Balion iNur.nc.. 6 rcqun.d by S(t ion I700 of fi. ribor Codc. to. rh. Ft'l!1s" 'r rhc worl fo. which rhis p6nil G su.d My $0116 comPasl ion i6!@c. cei6 d policy nunb.r &.: I cdilyrh.l in rhe D<r(nEn.. oar lE *or k ior shich rhirpâ‚¬rnriris isstred.I shrllnor onploy an! lEr$n in {nr r mr a, 6roh.{o,nesubidtorhcr0r[6 co'np.nsaii.nli*s.f(alitortria.andarr.c lshollll h.ron suhidl to lh. s0116 co rpderhnpm\hionsofs6rnrn.rT00ollh.Labor(ode. lrhill, lnn conrflr_ s h rh.e pmvisions. W RNINC l;ailuc lo Bur. tr.rlcre .oDp.nsaln,n cavemlr r unl.\lul. cnil fines up lo onc hundr.d lhouend dolla6 It100,000). ,n addnh to I inrerBt and dlocr\ a$ ZO I hc'!h) amnnundd pfiallv o I Fjury ihai Ln li.asn mdo r.Yorisnrn ol( h.Ptd q (commo(ihs sirh s.dion ?Unl 'fDniri'n 1 of rhe llusinnsand Ptufsn'ns (-ode. a.d nry hc..* is in iulllorcc dcffeci :: \t% l/i ,"rr.".r"rX, CQNSIAUCIIAN]IIDINIi.&AEIq I h*by amrm und.r p.nslry o f pdjury thal ltrc is . coNrrucli.. Lndins lsocy fot rh. Faommc. olltu worl aor \vhicfi lhn p.rnn b iiu.d (S.c. 1097. Ci! C ). I cnJn'r Nam. Af PLI('AN'I I'E(]LAR-4 ION lhdd]} arra! trndcr pdalr) ofpdjuryonâ‚¬oflhclollosin! deld ions Dcmolnion Permirs-AsbsxN Norin.alion I'cderal Rcrulalions {Tnh 40. Pa16) R((o rcd I elicr.f Nor'licxf. I cdl,tytharrhrfi\l.r.lrcAUlaiionsEga iins I cdiiayrhd I narcrcadlhisappli.ariona slarc otr(r I.!E to.oNply s ilh allCir, and ( ounly onlnan.6.nd sralet a** r.larin* ro btrilding ab.E rncnr i.n.d ropsiy for inspElionF \pplicairl or aEC t Shn.ltrre: Sea% '"':'"::;J;j;;" Forms/Steel/Holdowns Y. fiAra_-]